CMS Issues Final Rule for Medicare Coverage of End-of-Life Talks

On Friday, the Obama administration issued a final rule that will allow Medicare to reimburse physicians for end-of-life discussions with patients, The Hill reports (Sullivan, The Hill, 10/30).

The rule will take effect Jan. 1, 2016 (Armour, Wall Street Journal, 10/30).

Background

CMS in July released a proposed rule that would provide Medicare coverage for end-of-life counseling. The change was included in CMS' proposed updates to the 2016 Medicare Physician Fee Schedule.

The move came after CMS last year declined an American Medical Association request to implement new billing codes for advanced-care planning in its 2015 physician payment rule. In addition, lawmakers in 2009 dropped efforts to include end-of-life planning in the Affordable Care Act after opponents of health reform cast it as the start of "death panels" that would encourage euthanasia (California Healthline, 7/9).

End-of-Life Counseling Rule Details

The final rule creates separate Medicare billing codes and provider reimbursement rates for end-of-life counseling. According to Modern Healthcare, the rule allows physicians to include end-of-life discussions as part of patients' annual check-ups. Physicians can also continue to be reimbursed for such discussions that occur during a patient's initial visit when he or she first enrolls in Medicare, which is already covered under the program (Rubenfire, Modern Healthcare, 10/30).  

CMS said the rule is "consistent with recommendations from a wide range of stakeholders and bipartisan members of Congress." CMS has also said the rule aligns with AMA's coverage recommendations (The Hill, 10/30).

Reaction

CMS CMO Patrick Conway said he recognizes "how important these discussions are for patients and families," adding, "We believe patients and families deserve the opportunity to discuss these issues with their physician and care team" (Rubenfire, Modern Healthcare, 10/30).               

Rep. Sander Levin (D-Mich.), who has advocated for such coverage, lauded the rule. He said in a statement, "Families should be able to talk-through and understand these medical decisions with a knowledgeable practitioner of their choosing."

Meanwhile, Rep. Earl Blumenauer (D-Ore.), who has also advocated for such coverage, said the change will "be amazingly consequential in making sure people get the care they want" and noted that the rule could save billions of dollars (The Hill, 10/30).

However, some stakeholders have said they oppose the change because it could lead to billing fraud.

In addition, Gary Puma, president and CEO of Springpoint Senior Living, said while his organization "would benefit" from the rule's "additional reimbursement from Medicare, [it] cannot in any way support this initiative." He noted that providers at his facility already have "discussions all the time when appropriate, with families, about end-of-life issues" (Wall Street Journal, 10/30).